Luijendijk R W, Hop W C, van den Tol M P, de Lange D C, Braaksma M M, IJzermans J N, Boelhouwer R U, de Vries B C, Salu M K, Wereldsma J C, Bruijninckx C M, Jeekel J
Department of Plastic and Reconstructive Surgery, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
N Engl J Med. 2000 Aug 10;343(6):392-8. doi: 10.1056/NEJM200008103430603.
Incisional hernia is an important complication of abdominal surgery. Procedures for the repair of these hernias with sutures and with mesh have been reported, but there is no consensus about which type of procedure is best.
Between March 1992 and February 1998, we performed a multicenter trial in which we randomly assigned to suture repair or mesh repair 200 patients who were scheduled to undergo repair of a primary hernia or a first recurrence of hernia at the site of a vertical midline incision of the abdomen of less than 6 cm in length or width. The patients were followed up by physical examination at 1, 6, 12, 18, 24, and 36 months. Recurrence rates and potential risk factors for recurrent incisional hernia were analyzed with the use of life-table methods.
Among the 154 patients with primary hernias and the 27 patients with first-time recurrent hernias who were eligible for the study, 56 had recurrences during the follow-up period. The three-year cumulative rates of recurrence among patients who had suture repair and those who had mesh repair were 43 percent and 24 percent, respectively, with repair of a primary hernia (P=0.02; difference, 19 percentage points; 95 percent confidence interval, 3 to 35 percentage points). The recurrence rates were 58 percent and 20 percent with repair of a first recurrence of hernia (P=0.10; difference, 38 percentage points; 95 percent confidence interval, -1 to 78 percentage points). The risk factors for recurrence were suture repair, infection, prostatism (in men), and previous surgery for abdominal aortic aneurysm. The size of the hernia did not affect the rate of recurrence.
Among patients with midline abdominal incisional hernias, mesh repair is superior to suture repair with regard to the recurrence of hernia, regardless of the size of the hernia.
切口疝是腹部手术的一种重要并发症。已有关于用缝线和补片修复这些疝的手术报道，但对于哪种手术方式最佳尚无共识。
在1992年3月至1998年2月期间，我们进行了一项多中心试验，将200例计划在腹部垂直中线切口长度或宽度小于6cm处进行原发性疝或疝首次复发修复的患者随机分配接受缝线修复或补片修复。在1、6、12、18、24和36个月时对患者进行体格检查随访。采用寿命表法分析切口疝复发率及复发的潜在危险因素。
在154例原发性疝患者和27例首次复发疝患者中，有56例在随访期间复发。原发性疝患者接受缝线修复和补片修复的三年累积复发率分别为43%和24%（P = 0.02；差异19个百分点；95%置信区间3至35个百分点）。疝首次复发修复时的复发率分别为58%和20%（P = 0.10；差异38个百分点；95%置信区间-1至78个百分点）。复发的危险因素为缝线修复、感染、前列腺增生（男性）和既往腹主动脉瘤手术。疝的大小不影响复发率。
在腹部中线切口疝患者中，无论疝的大小，补片修复在疝复发方面优于缝线修复。
